Antenatal corticosteroids for pregnant women at risk of preterm labour in low- and middle-income countries: utilisation and facility readiness.

Background: Administering antenatal corticosteroids (ACS) to pregnant women at risk of imminent preterm labour improves newborn survival. However, ACS remains substantially underused in low- and middle-income countries (LMICs), where most preterm births occur globally. Providing ACS in inadequately equipped settings can be harmful. Health facilities must demonstrate readiness to ensure safe and effective ACS use. We aimed to assess ACS utilisation and facility readiness to administer ACS based on the World Health Organization (WHO) recommendations. Methods: We used data from Service Provision Assessments in nine LMICs. The primary outcome was ACS utilisation, which was defined as having ever provided ACS in a health facility. We assessed the availability of injectable corticosteroids (dexamethasone or betamethasone) and facility readiness to administer ACS appropriately. To measure readiness, we developed an overall readiness index based on 35 indicators, grouped into four categories based on WHO recommendations. The results were stratified by facility level. Results: Across eight countries with comparable sampling strategies, only a median of 10.7% (range = 6.7-35.2%) of facilities had provided ACS, one-fourth (median = 25.3%; range = 4.6-61.5%) had injectable corticosteroids available at the time of the survey. Significant gaps were observed between corticosteroid availability and ACS use. We found low overall readiness indices, ranging from 8.1% for Bangladesh to 32.9% for Senegal. Across four readiness categories, the readiness index was the lowest for criterion one (i.e. ability to assess gestational age accurately) (7.3%), followed by criterion two (i.e. ability to identify maternal infections) (24.8%), criterion four (i.e. ability to provide adequate preterm newborn care) (31.3%), and criterion three (i.e. ability to provide adequate childbirth care) (32.9%). Conclusions: We proposed a strategy for measuring facility readiness to implement one of the most effective interventions to improve neonatal survival. Countries should operationalise readiness measurement, improve facility readiness to provide ACS appropriately, and encourage ACS uptake in well-equipped facilities.